Perfectionism

I've been going for CBT for three weeks now, and I have to say that day by day I am getting better at challenging my negative thoughts. Whether that is due to the CBT, medication or other factors such as being back at work I will never know.

Keeping my little thought diary has shown me how desperate I am to please others and how much I fear criticism or punishment. Yesterday my therapist pointed out that this tendency has its benefits. It drove me to succeed through A-levels and medical school. I have managed to command a lot of respect over the years from people around me. I've won prizes. I have a great CV. But then there's the flip side. The moment when failing to achieve my goals becomes intolerable to me and I give up altogether. Many people with depression and bipolar disorder are very talented and successful when well. Is this why? Are talented people prone to depression when the praise dries up?

I've received so much praise in my life. From the age of five I was reading and writing better than anyone in my class. I was way ahead when it came to maths and languages. OK, so sport was never my strong point, but you can't have everything. The point is – I was constantly told I was clever by both teachers and a pair of loving parents. So when I moved to a bigger school with pupils as clever as me it was a shock. I managed to get over it and climb my way back up the academic ladder. Yet by the time I hit medical school I was definitely mediocre. Indeed, in my current friendship circles I still am mediocre.

My default mindset seems to be that I am a) stupid, b) fat, and c) unpopular. Luckily this mindset tends to be challenged on a daily basis unknowingly by others. I might get good feedback from a senior doctor; I might squeeze in to a small dress and note the fact that my BMI is only 21; I might find myself surrounded by friends and having a good time. When I am well I can get away with the odd reminder that I'm not as bad as I think I am. But when I am unwell I need constant praise and signals from others to stop me from sinking... And life's just not like that is it?  

Weight problems...

I've gained 2kg.

Okay, so that doesn't sound like that much. But in reality I've noticed my underwear is a little on the tight side. When I moan about my weight my boyfriend just roles his eyes and says he can't see any change in my appearance. We went on holiday last week, and looking back at the photos all I can see is how flabby my arms are starting to look (again, my boyfriend supposedly can't see this the way I can).

What bothers me isn't the weight gain itself, it's the question of why this has happened. Whatever it is has to be nipped in the bud or I'll risk gaining another 2kg next month. Deep down I know it's related to my mood. I'm not one of those depressives who draws attention to themselves by wasting away. I find myself slipping from a relatively active lifestyle to dividing time between my bed and my sofa. Pretty much all that gets me out of bed is food, as I suspect my writing has revealed. Is that such a bad thing though? When all is dark around you to hold on tight to any remaining source of pleasure in your life?

I've decided to avoid the temptation to respond to this with starvation. I've been through too many periods of self-starvation and subsequent overeating to entertain the notion that it would actually work. The plan is to gently increase my exercise levels and maybe ease off cake for a bit. I'm not an idiot, I know what my body needs to stay healthy. So why is it so damn difficult? I guess that long-term lifestyle changes require a degree of mental stability. I'm much better than I was a month ago, but in general I am an impulsive person. It's so tempting to hugely restrict my eating for a few days just to become giddy with excitement as the numbers on the scales drop slightly. Alas, the excitement never lasts. And when you enjoy food like I do starvation's a real mood killer.

Besides, I don't actually need to lose weight. I calculated my BMI and technically I'm still "healthy". I'd have to gain well over a stone before I'd be classed as overweight. But that doesn't take away my distress at the knowledge that I'm now (almost) the highest weight I've ever been. I've decided to bite the bullet and discuss the issue with my GP tomorrow, but I'm scared he'll just point out that I'm a healthy weight and leave it at that. We'll see.

I read a great blog post on the subject (here) the other day. Turns out it's not just me struggling with my body as well as my mind. If anyone has any other tips for managing to keep your body healthy in the face of a mood disorder I'd be glad to hear it.